基于旋髂浅动脉设计的联体皮瓣修复下肢大面积软组织缺损  

The SCIA-based conjoined flap for covering extremely large lower limb defects

作　　者：唐林 周鑫 黄宇 黄波 刘安铭 陈孝均 邹永根 TANG Lin;ZHOU Xin;HUANG Yu;HUANG Bo;LIU Anming;CHEN Xiaojun;ZOU Yonggen(Department of Hand Surgery,The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,Luzhou,Sichuan Province 646000,China)

机构地区：[1]西南医科大学附属中医医院手外科,四川泸州646000

出　　处：《中华显微外科杂志》2022年第2期175-180,共6页Chinese Journal of Microsurgery

摘　　要：目的探讨基于旋髂浅动脉(SCIA)设计的联体皮瓣修复下肢大面积软组织缺损的临床疗效。方法回顾分析2017年2月-2019年6月收治的脱套伤致下肢大面积软组织缺损患者15例,缺损范围为25.0 cm×8.0 cm~50.0 cm×15.0 cm。急诊予以彻底清创及创面VSD处理,待创面肉芽组织生长红润后,以下腹壁及侧胸壁为供区,根据创面特征设计形状及大小匹配的联体皮瓣;穿支组合包括双侧SCIA、SCIA加胸背动脉(TA)降支;供区直接一期闭合;由同一组医生门诊随访评估术后效果。结果术后除1例纵向皮瓣边缘部分坏死,经二期植皮后愈合,其余皮瓣全部成活,供、受区创面均Ⅰ期愈合。随访时间16~24个月,平均18个月;皮瓣外形满意,质地柔软,末次随访时未出现异常毛发生长、色素沉着等;供区仅遗留线形瘢痕,未出现腹壁疝等并发症,肩、髋、膝活动未受影响;小腿及足踝功能重建满意,按下肢功能评定标准(LEFS)评分,优7例、良1例,按美国矫形足踝协会(AOFAS)评分标准评定,结果优6例、良1例。结论基于SCIA制备的联体皮瓣,供区隐蔽,设计灵活,切取面积大,能修复肢体大面积软组织缺损,以最大程度实现保肢治疗。Objective To investigate the results of the superficial circumflex iliac artery(SCIA)-based conjoined flap for covering extremely large lower limb defects.Methods From February 2017 to June 2019,15 patients were admitted,who suffered from severe degloved injury for the lower limb,including 9 males and 6 females with a median year of 45(ranged,36-67)years old.All were taken thorough and radical debridement and covered by the VSD device during the emergency operation.The dimension of defects was ranged from 25.0 cm×8.0 cm to 50.0 cm×15.0 cm.Using the lower abdominal wall or side chest wall as the donor site,the conjoined flap was dissected when the wound surface became granulating.The perforator match fashions included bilateral SCIA,and ipsilateral SCIA and thoracodorsal artery(TA).The donor sites were primary closure.The follow-up was accomplished by the same surgeon.Results Fourteen flaps survived completely without significant complications,and distal necrosis was observed in one longitudinal flap,which was healed with the skin graft in the second stage.All flaps were available for a mean follow-up of 18(ranged 16-24)months.The aesthetic outcomes were achieved on the recipient site without hairy appearance and hyper-pigmentation.A concealed line scare was left on the donor site,without the hernia and limited function.At the last follow-up,7 cases were excellent and 1 case was good,evaluated with the LEFS criteria.And 6 cases were excellent and 1 case was good,assessed by the AOFAS criteria.Conclusion The simultaneous reconstruction of extreme lower limb defects and better salvage treatment could be achieved by the SCIA-based conjoined flap.And as a versatile flap,it was blessed with concealed donor site,various design fashions,and larger dissection size in selected cases.

关 键 词：旋髂浅动脉 胸背动脉 联体皮瓣 下肢 修复 

分 类 号：R658.3[医药卫生—外科学]